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In battle for Merced County ambulance contract, details matter

Riggs Ambulance Service and American Medical Response haven't agreed on much since bidding for the county's emergency services contract began.

But now, there's another difference dividing the two agencies -- the reporting of two pieces of data.

Mutual aid requests, which are made when an agency asks for help from another provider, and "Status 0" events, when there are no ambulances available, are not captured or reported by AMR.

Mountain-Valley EMS Agency provides oversight and regulation of AMR's service in Stanislaus County, in addition to writing, managing and regulating contracts for four other California counties.

According to AMR's director of communications Jason Sorrick, the agency does not require AMR to report the number of mutual aid requests and Status 0 events per month.

The agency's Executive Director Richard Murdock confirmed that AMR's contract doesn't require it to report mutual aid requests and Status 0 events, because they are rare.

"In the current contract, there is no language specific to AMR reporting mutual aid or Status 0," Murdock said. "We don't have a problem with Status 0, so there's no need to monitor it. It doesn't happen very often with AMR, and I can't think of one day that AMR was at Status 0 in Stanislaus County."

However, Riggs is required by its contract with Merced County to report these two measurements.

"Our opinion is that Status 0 is not a valuable measurement, whereas on-scene response times are," said Riggs Ambulance Service General Manager Don Vonarx. "As far as we know, we're the only ones required to measure that."

Based on Merced County's mutual aid reports, Riggs received AMR's assistance for 14 out of 19 requests in April 2012.

In contrast, AMR received mutual aid assistance from Riggs only four times for the entire year in 2011, according to Merced County records.

Riggs officials said they have a 24-hour ambulance stationed in Delhi, and aren't sure why AMR hasn't utilized Riggs' resources when it runs out of ambulances in Turlock.

Sorrick said that AMR wouldn't disregard Riggs' mutual aid, but the help was just not needed. "If we don't need mutual aid, we don't need to call them," Sorrick said. "We staff enough units in our system to ensure we don't have to use mutual aid on a regular basis."

According to June Iljana, deputy director for California EMS Authority, there isn't a national standard for mutual aid requests or Status 0 events.

Iljana said that it varies by each county's contract, but rural counties rely on mutual aid more often.

Riggs officials maintain that the company's mutual aid requests are in compliance with its contract, which defines "excessive" mutual aid requests as 3 percent of call volume.

Vonarx said Riggs' mutual aid requests have never exceeded 2 percent to date.

Status 0 events could not be compared between the two agencies, as that data was not available for AMR.

One thing the two companies have in common is that they've both met a compliance standard of 90 percent or better for call response times.

In the April 2012 report, AMR met its overall compliance by 90.52 percent. In comparison, Riggs met its compliance by 93.57 percent for the same month.

AMR's compliance reports from last year reflect the same pattern.

Based on the average of six monthly reports from April 2011 to December 2011, AMR met its compliance in Stanislaus County by 91.92 percent -- slightly lower than Riggs' average of 93.52 percent for the same period.

Providing service to a rural county such as Merced presents many challenges, Sorrick said. "Rural counties are much more difficult to service, because it takes you longer to respond and get back," he noted.

Adding to the challenge is the tough economy and areas with a higher Medi-Cal or Medicare population.

Depending on the mileage, Medi-Cal pays a range of $110 to $140 for services and Medicare pays up to $500, Sorrick said. He estimates that about 50 percent of AMR's claims do not get paid.

Vonarx added that only 11 percent of Riggs' patients have private insurance, and that Riggs is reimbursed about 28 cents for every dollar that it bills.

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